MedCity Influencers, Health Tech

Why 2022 will be a pivotal year for interoperability and the patient experience

We’ve been through the beginning phases of interoperability and are solidly transitioning from walking to running. I believe 2022 will be a pivotal year that sees us opening the throttle and rocketing full speed ahead.

Laptop and download file

I think we can all agree that healthcare has made significant progress over the past few years toward achieving interoperability. From the passing of the 21st Century Cures Act in 2016 to the global adoption of FHIR to the ongoing progress of the CMS Patient Access Final Rule—we are headed in the right direction and finally making traction. We will reach even more momentum in 2022.

While government regulations continue to push the industry forward toward interoperability, we’ve seen much of the progress coming from forward-thinking local or regional organizations that decide to act on their own. Health systems have invested significantly in connecting with providers inside and outside of their network, Payers are building connecting through EHRs with providers in their regional networks. At state and regional levels, Contexture, the merger of Health Current and CORHIO is a great example of how HIEs are combing to create one of the largest health data exchanges in the nation. Contexture includes 1,800 healthcare organizations across Colorado and Arizona. This momentum of building connected communities at the local and regional level will continue as technologies make that connectivity easier and as organizations realize the true benefits—clinically and operationally—of working together.

In the coming year, we would like to see healthcare begin to expand its interoperability efforts to include more administrative functions in addition to clinical data. Administrative functions such as claiming, revenue cycle, eligibility, prior authorization, coverage, and others require data exchange and are currently very inefficient and costly, based mostly on individual point-to-point connections. The lack of interoperability with administrative data leads to a negative patient experience by causing delays in care, incorrect patient bills, unnecessary member and patient support calls, and more. Creating interoperable methods to share data with multiple parties via a single connection will gain momentum in 2022.

Wider adoption of blockchain in healthcare

Blockchain is most known for being used for cryptocurrency, NFTs, and smart contracts. However, there are more ways to use blockchain and in 2022, healthcare will make progress on leveraging blockchain.

In the coming year, we will begin to see realistic short-term blockchain use cases while still considering blockchain’s long-term transformative potential. For example, on the revenue cycle side, use cases include eligibility verification, prior authorization, and real-time access to updated and complete medical records. Addressing data flow inefficiencies in healthcare would help immensely and save tens of billions of dollars annually, according to CAQH 2020 Index Report. That’s a near-term use case for blockchain that is achievable.

One of the best opportunities to leverage blockchain is to improve the fluidity of data exchange between patients, providers, payers, and vendors. This is where blockchain shines — decentralized ledgers house accurate and immutable information about the individual that can be accessed with the appropriate permissions. Certification, cybersecurity, and compliance will be provided by an independent network intermediary.

With a blockchain-enabled network, the need for point-to-point connectivity is eliminated by creating an environment of “connect once to many.” Also, a blockchain-enabled network functions as a verifiable trust layer for joint processes between participants on the network. Because of that agreed, verifiable trust function, counter-party risk of data sharing is significantly reduced. Each participant on the blockchain knows, with a certified verification that the other participants are “good actors” and agree to interact with each other using automatically enforced standards. No other middleman data processing entity is needed to guarantee the integrity of the data or transaction. Only once all the participants verify trust against the others in how, why, and when they interact, then truly continuous dynamic data updates and sharing becomes possible. This is the vision for the future state for all healthcare organizations.

Having a neutral blockchain network will eliminate the need for organizations to build and maintain multiple gateways with multiple entities to accommodate multiple data formats. This is achieved by shifting from data exchange to data access, IT costs lower, and efficiencies are gained.

Increasing trend toward community collaboration and innovation

Shared values. Common goals. Community. These are phrases we should get used to hearing. In tandem with advances in interoperability, blockchain and other emerging technologies, we will begin to see a greater effort toward reducing friction, building trust, and advancing cooperation among all industry stakeholders in the year ahead.

By providing everyone associated with a patient’s care access to the same accurate data, we will greatly reduce gaps in care, delays in care, medical errors, duplicate testing, and so much more including cost of care. In terms of the revenue cycle, payers and providers will be able to eradicate fraudulent claims, rejections and denials, and delayed reimbursements. Just the savings in reduced waste, fewer administrative burdens, and improved efficiencies will be enough to propel us forward.

The reality

Healthcare has experienced dramatic change since 2020 and with these tailwinds of change, we will see the innovative, transformational spirit continue into 2022. We’ve been through the beginning phases of interoperability and are solidly transitioning from walking to running. I believe 2022 will be a pivotal year that sees us opening the throttle and rocketing full speed ahead.

Stuart Hanson is passionate about creating a better consumer healthcare experience and has joined Avaneer Health as CEO to build an inclusive network that ensures all stakeholders have equal access to comprehensive data when it’s needed most. Stuart previously served in leadership roles for healthcare solutions at JPMorgan Chase, Change Healthcare, Citi, and Fifth Third Bank. He has served as chair of the HIMSS Revenue Cycle Improvement Task Force. Stuart has a bachelor’s degree from University of Illinois and an MBA from University of Chicago Booth School of Business. Stuart is a dynamic, innovative leader committed to improving the healthcare ecosystem.

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.